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A 53-year-old woman with a three-year history of recurrent stage IV diffuse aggressive lymphoma involving the nasopharynx presented with fever, chills, and the sudden onset of drainage of clear, colorless fluid from the left nostril. This woman had no history of trauma or physical activity that might increase intracranial pressure. Subarachnoid instillation of 111indium resulted in the accumulation of radioactivity in a cotton stint placed in the left nares, documenting cerebrospinal fluid rhinorrhea. Computed tomography of the head revealed bony erosion of the cribriform plate by lymphoma. Defervescence occurred in the patient 48 hours after treatment with antibiotics was begun, and systemic chemotherapy directed against the lymphoma resulted in resolution of the cerebrospinal fluid rhinorrhea within a month without surgical intervention.

Hypercalcemia has been infrequently associated with Hodgkin's disease. When seen, most cases have been attributable to skeletal invasion by disease. Herein is described a 40-year-old man with a 15-year history of Hodgkin's disease. Each of four disease recurrences was heralded by hypercalcemia occurring in the absence of bone disease or elevation of parathyroid hormone levels. Marked elevations of 1,25-dihydroxyvitamin D levels were observed that paralleled his disease course and response to therapy. The repetitive association of hypercalcemia with an elevation of 1,25-dihydroxyvitamin D in this case provides further evidence of lymphoma-associated production of this vitamin.